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Associate SIU Coding Auditor

Remote Full-time $75.3K/yr - $98.8K/yr

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Key Responsibilities:Conduct quality checks of coding audit reviews performed by team members, providing feedback in written or verbal form to ensure adherence to coding standards and Oscar's policies. Analyze dashboards and performance data to support production goals; proactively recommend actions to management to address potential issues before deadlines. Identify and assist in developing new processes to enhance the efficiency and effectiveness of audit functions. Perform detailed reviews of medical records and claims, both prepayment and post-payment, to confirm the accuracy of claims submitted to Oscar. Thoroughly document findings, citing sources to support decision-making in a manner comprehensible to non-clinicians and coders. Engage in educational interactions with providers involved in SIU reviews to communicate findings effectively. Facilitate educational sessions for team members and cross-functional teams. Ensure compliance with all relevant laws and regulations. Additional duties as assigned.

About the job

Join Oscar as an Associate, SIU Coding Auditor and become a vital part of our Special Investigations Unit (SIU). At Oscar, we are committed to revolutionizing health insurance through our advanced technology platform and a member-first approach. Since our inception in 2012, we have strived to create a health insurance experience that feels as caring and considerate as having a family doctor.

Role Overview:

As the Associate, SIU Coding Auditor, you will play a crucial role in implementing Oscar's anti-fraud initiatives, aligning operational and financial objectives while ensuring compliance with all legal and regulatory requirements. You will contribute to our audit strategy, maintain high-quality standards, and collaborate across teams to recommend process improvements that enhance our Fraud, Waste, and Abuse program. We seek individuals with a keen eye for detail, innovative thinking, and the flexibility to adapt to evolving operational needs.

You will report directly to the Manager of SIU Coding Audit.

Work Location: This position is fully remote, open to candidates residing in Arizona, Florida, Georgia, or Texas. While your daily responsibilities will be conducted from your home office, occasional travel for team meetings and corporate events may be required. #LI-Remote

Compensation: The base salary range for this role is $75,265 - $98,785 per year. Additional benefits include participation in Oscar's unlimited vacation program and eligibility for annual performance bonuses.

About Oscar Health

Oscar is a pioneering health insurance company that leverages a comprehensive technology platform to deliver unparalleled service to its members. Our mission is to create a health insurance experience that is personalized, transparent, and efficient, enabling our members to lead healthier lives.

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